Recently, I was involved in the assessment of a patient who presented with the chief complaint of a changing bite. The primary dentist was concerned about an alteration between the mandibular and maxillary arches, which had happened within the two years he was following the patient.
The patient, a woman in her middle 40s, denied any reason for this change, and the dentist denied having done any significant dental treatment that could have caused it. Since assessment of other conditions, such as bony or soft tissue tumors had been previously ruled out by appropriate specialists, I reviewed the patient’s history again. She was accompanied by her spouse, and as I questioned her as to her general sleep conditions and routine questions of snoring and sleepiness,Citation1 she kept denying any problems, while looking at her husband.
Being curious, I turned to the husband and asked him if there were any issues with her sleep, and he replied that in the past, she had been diagnosed with severe sleep apnea, but after she had been on a nasal CPAP (nCPAP) device, the problem of gasping and waking up at night was no longer an issue. She had been on an nCPAP for the past two years.Citation2
The patient had not told the dentist about this since she was not on the device at the first appointment and later was never asked about any sleep aspects. Medical history was regularly updated as to medications and other systemic conditions, but she did not think the dentist needed to know about the nCPAP since ‘it was not her mouth.’
To many in the field of dental sleep medicine, this may come as a surprise, but the average dentist is not aware that long-term therapies for sleep apnea may cause changes to the teethCitation3 and craniofacial structuresCitation2 either by a mask worn on the face or by dental sleep appliances worn at night.Citation4 As in the case of our patient, the nCPAP has been known to be a risk factor in bite changes and flattening of the midface region.Citation2
There has been a lack of this information imparted in dental training programs,Citation3 and it is only now that dental sleep medicine is coming into mainstream dental education.Citation5 As more and more people are diagnosed with sleep disturbances,Citation1,3 the incidence of dental changes taking place related to various CPAP wear,Citation2 tongue retaining (TR),Citation5 and mandibular advancement devices (MAD)Citation6,7 will need to be front and center in every dentist’s risk factor assessment for tooth movement.
Tufts Craniofacial Pain Center, Boston, MA, USA
Email: [email protected]
References
- Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep–related breathing disorders. An american academy of sleep medicine report. Sleep. 2006;29(3):375–380.
- Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe A. Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea. Chest. 2010;138(4):870–874.10.1378/chest.10-0678
- Almeida F, Lowe A, Tsuiki S, Otsuka R, Wong M, Fastlicht S, Ryan F. Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome. J Clin Sleep Med. 2005;1(2):143–52.
- Andrew S, Chan H, Lee RW, Cistulli PA. Dental appliance treatment for obstructive sleep apnea. Chest. 2007;132:693–9.
- Almeida F, Lowe A. Principles of oral appliance therapy for the management of snoring and sleep disordered breathing. Oral Maxillofac Surg Clin Am. 2009;413–20.10.1016/j.coms.2009.07.002
- Chen H, Lowe A, Almeida F, Ueda H, Fleetham J, Wang B. Dental changes evaluated with a 3D computer-assisted model analysis after long-term tongue retraining device wear in OSA patients. Sleep Breath. 2008;12:169–78.
- Marklund M. Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea. Am J Orthod Dentofac Orthop. 2006;129:214–21.10.1016/j.ajodo.2005.10.004